New procedural rules could prevent nearly 50% of children from receiving unnecessary ankle X-rays, according to a study published in the Canadian Medical Association Journal.
Dr. Kathy Boutis and colleagues conducted a study to see if hospitals could cut down on the number of children who receive radiographs on their ankles for minor injuries. Dr. Boutis believed many children were receiving radiographs for what she termed “low-risk” ankle injuries. She hoped that through new procedural rules and a streamlined emergency department system, a large portion of children could have their ankle injuries diagnosed without the use of an X-ray.
The Study
Dr. Boutis recruited six hospitals to participate in the study. Three of the hospitals received new procedural guidelines while the other three hospitals acted as a control group. The hospitals that undertook the new rules treated 1055 children with ankle injuries during the study, while the control hospitals treated 1,096 children.
The hospitals with the new guidelines implemented a three-phase system that included:
- An initial phase where baseline data was collected;
- A second phase that included intervention; and
- A final phase that used a decision support system to determine treatment protocols.
The second phase was arguably the most important phase for medical professionals, as it was during this stage that they underwent training and received guidelines of the “Low Risk Ankle Rule”.
The Low Risk Ankle Rule said that if a child suffered an ankle injury that had a low risk examination, radiography could be avoided. Children were determined to have a low risk examination if tenderness and swelling were isolated to the distal fibula and/or adjacent lateral ligaments distal to the tibial anterior joint line.
After a physician assessed a child’s injury, they would input their findings into a computerized decision support system. Based on their findings in regards to appearance, symptoms and other factors, the system would automatically determine the risk associated with the ankle injury and if the Low Risk Ankle Rule should be applied.
The Results
According to researchers, during the intervention stage physicians reduced the use of radiography by 22 percent compared to the control group without any significant differences in patient satisfaction. They also concluded:
- The Low Risk Ankle Rule could have been used in 430 of 628 cases in the second and third phases, and they followed the rule recommendations in 350 cases.
- The two main reasons why the Low Risk Ankle Rule wasn’t followed in the cases that qualified were because physicians feared missing a significant fracture, and because the child’s family preferred an X-ray.
- Researchers believed had all physicians completely complied with the rule, 49.5 percent of X-ray procedures could have been avoided.
While similar studies will certainly follow, the researchers were pleased with their findings.
“The ankle rule has potential broad applicability to emergency departments throughout most of the developed world, and widespread implementation of this rule could safely lead to reduction of unnecessary radiography in this radiosensitive population and a more efficient use of health care resources,” researchers concluded.
Related source: Medscape
